I didn’t actually see the robot. My mind had already been switched off, by anaesthetists, ahead of my bed being wheeled into the operating theatre. It was probably just as well.
Later, when my mind had restarted, and I was lying in recovery in my hospital ward, I checked. Yes, there were six small plasters on my abdomen, covering six small wounds (“ports”), that the urology surgeon had told me he would create in order for the da Vinci robot to work its magic.
The point of the operation was to remove the central core of my prostate – an organ that sits toward the back of the body and which is difficult to access.
The prostate wraps around the urethra – the channel through which urine flows from the bladder into the penis. The typical size of a prostate for a man aged twenty is around 20 ml. By age sixty this may have doubled. The larger the prostate, the greater the chance of interference with normal urine flow. In my own case, I had experienced various episodes over the last ten years when urination was intermittently difficult, but matters always seemed to right themselves after a few days. Then at the beginning of September, I found I couldn’t pass any urine. What made matters more complicated was that I was away from home at the time, on a short golfing holiday in Wiltshire. The golf was unusually good, but my jammed up bladder felt awful.
Following an anxious call to the NHS 111 service, I was admitted to the Royal United Hospital in Bath where, after a couple of false starts, an indwelling catheter was inserted through my urethra. Urine gushed out. I felt relieved as never before.
In a way, that was the easy bit. The harder question was what long-term approach to take.
A six-week trial of a muscle-relaxant drug called Tamsulosin had no impact on my ability to pass urine unaided. Measuring the size of my prostate via a transrectal ultrasound procedure clarified options: it was a whopping 121 ml.
The radiologist said “This is not the largest prostate I have ever seen”, but it was clear my condition was well outside the usual range. Not only would changes in medication or diet be very unlikely to produce a long-term solution for me. But most of the more standard prostate operations (there are a large family of possibilities, as I discovered) would not be suitable for a prostate as large as mine. The risks of adverse side-effects would be too large, as well as recurrence of prostate pressure in the years to come.
That led my consultant to recommend what is called a robotic-assisted simple prostatectomy. The “simple” is in contrast to the “radical” option often recommended for men suffering from prostate cancer. In a simple prostatectomy, the outer part of the prostate remains in place, along with nerve and other connections.
Over several hours, whilst my mind was deanimated, the robotic arms responded to the commands issued by the human surgeon. Some of the ports were used to introduce gas (CO2) into my abdomen, to inflate it, creating room for the robotic arms to move. Some ports supported illumination and cameras. And the others channelled various cutting and reconstruction tools. By the end, some 85% of my prostate had been removed.
It might sound cool, for a technology advocate like myself to receive an operation from a high-precision robot. But in reality, it was still a miserable experience, despite the high-calibre professional support from medical staff. The CO2 left parts of my body unexpectedly swollen and painful. And as time passed, other swellings known as oedemas emerged – apparently due to fluid.
I learned the hard way that I needed to take things slow and gentle as I recovered. In retrospect, it was a mistake for me to walk too far too soon, and to take part in lengthy Zoom calls. My sleep suffered as a result, with shivering, sweating, coughing fits, and even one black-out when I went to the bathroom and felt myself about to pass out. I had the presence of mind to lower my head quickly before the lights went out altogether. I came to my senses a few moments later, with my upper torso sprawled in the bath, and my lower body hanging over the edge. Thank goodness no serious damage ensued from that mini collapse. The only good outcome that night was when I took a Covid test (because of the coughing) and it came out negative.
Ten days later, things are closer to normal again. It’s wonderful that my internal plumbing works smoothly again, under my control. But I’m still being cautious about how much I take on at any time.
(If you’re waiting for me to reply to various emails, I’ll get round to them eventually…)
More good news: tests on the material removed from my body have confirmed that the growth was “benign” rather than cancerous. My wounds are healing quickly, and I am almost weaned off painkillers.
I have no regrets about choosing this particular surgical option. It was a good decision. Hopefully I’ll be playing golf again some time in January. I am already strolling down some of the fairways at Burhill Golf Club, carrying a single club in my hand – a putter. I drop a golf ball when I reach the green. Sometimes I knock the ball in the hole in two putts, or even just one. And sometimes it’s three putts, or even more. But the fresh air and gentle exercise is wonderful, regardless of the number of putts.
The bigger lesson for me is a message I often include in my presentations: prevention is better than cure. A stitch in time saves nine.
Earlier attention to my enlarging prostate – either by a change of diet, or by taking medicines regularly – may well have avoided all the unpleasantness and cost of the last few months.
As for the prostate, so also for many other parts of the body.
This year, I’ve been thinking more and more about the good health of the mind and the brain. With my reduced mobility over the last few months, I’ve had time to catch up with some reading about brain rewiring, mental agility and reprogramming, the role and content of consciousness, and ways in which people have recovered from Alzheimer’s.
Once again, the message is that prevention is better than cure.
If you’re interested in any of these topics, here’s an image of some books I have particularly enjoyed.
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